This post is based on my opinion as a mental health expert and is not a formal diagnosis, by any means.
The Goldwater Rule’s insistence that it is unethical for a mental health professional to comment on a public figure’s psychological functioning without an interview is misguided and without scientific foundation. If anything this increases the stigma around mental health issues.
The DSM is based upon observable diagnostic material. When you undertake a face-to-face assessment, poor self-insight, dishonesty and other variables could lead to misdiagnosis if a practitioner is unable to use their experience and observable criteria to formulate a diagnosis.
Furthermore, since the Goldwater Rule was adopted (1973) there has been substantial multi-disciplinary research questioning the necessity of an in-person interview as the sole basis for assessment in all circumstances.
After years of working as a therapist, it becomes easier to identify patterns of behaviour. I am concerned for Meghan Markle, because if she does have mental health issues (such as Narcissistic Personality Disorder or many traits of narcissism) she is vulnerable.
Individuals with this disorder think in a certain way that is automatic and ‘normal’ to them. This is due to significant patterns of neural wiring in the brain. It is still not clear whether the ratio of this pattern is largely down to nurture or nature, or (most likely) a combination of both.
As a result, what they see as normal may be seen by others as self serving, self promoting or spoiled and entitled.
Narcissistic personality disorder (NPD) is characterized by a long-standing pattern of grandiosity (either in fantasy or actual behavior), an overwhelming need for admiration, and usually a complete lack of empathy toward others. They can feign empathy though as a way to get what they need. People with this disorder often believe they are of primary importance in everybody’s life — and to anyone they meet. While this pattern of behaviour may be appropriate for a king in 16th century England, it is generally considered inappropriate for most ordinary people today.
People with Narcissistic Personality Disorder often display snobbish, disdainful, or patronizing attitudes. For example, an individual with this disorder may complain about a clumsy waiter’s “rudeness” or “stupidity,” or conclude a medical evaluation with a condescending evaluation of the physician.
Personality Disorders aren’t necessarily bad, they are formed by our unique wiring pattern in the brain
It’s important to view mental health issues as symptomatic of the way their brain is ‘wired’. Neural pathways are created according to our early experiences in life. Our mental ‘wiring’ can explain many behaviours and patterns of thinking. Personality Disorders should be viewed in the same way as anxiety, depression, obsessive-compulsive disorder, autistic spectrum disorder, dyslexia etc.
Many people assume a personality disorder is a bad thing but the more we educate ourselves and talk about mental health disorders, the more we normalise the different ways of thinking and behaving. When we open up discussions about mental health, the more tolerant we will be of the manner in which others behave.
In layperson terms, someone with this disorder may be described simply as a “narcissist” or as someone with “narcissism.” Both of these terms generally refer to someone with Narcissistic Personality Disorder.
A personality disorder is an enduring pattern of inner experience and behaviour that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.
SYMPTOMS OF NARCISSISTIC PERSONALITY DISORDER (DSM CRITERIA)
In order for a person to be diagnosed with narcissistic personality disorder (NPD) they must meet five or more of the following nine symptoms:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
- Requires excessive admiration
- Has a very strong sense of entitlement, e.g., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
- Is exploitative of others, e.g., takes advantage of others to achieve his or her own ends
- Lacks empathy, e.g., is unwilling to recognize or identify with the feelings and needs of others
- Is often envious of others or believes that others are envious of him or her
- Regularly shows arrogant, haughty behaviors or attitudes
Because personality disorders describe long-standing and enduring patterns of behaviour, they are most often diagnosed in adulthood. It is fairly uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes, and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.
Narcissistic Personality Disorder is more prevalent in males than females and is thought to occur in around 6 percent of the general population, according to research.
Like most personality disorders, NPD can decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in their 50s.
Learn more: Symptoms of narcissistic personality disorder
HOW IS NARCISSISTIC PERSONALITY DISORDER DIAGNOSED?
Personality disorders such as NPD are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood, or genetic tests that are used to diagnose personality disorder.
Many people with this disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.
A diagnosis for narcissistic personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.
CAUSES OF NARCISSISTIC PERSONALITY DISORDER (NPD)
Researchers today don’t know what causes NPD. There are many theories, however, about the possible causes of narcissistic personality disorder.
Most professionals subscribe to a biopsychosocial model of causation — that is, the causes are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important.
If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children. While some of this has to do with genetics, some of is also likely due to the child’s personality, as well as the parenting behaviour of one or both of the parents.
HOW NARCISSISTS SELF SABOTAGE
Unlike Sociopaths who know exactly how they are impacting upon others, a narcissist thinks in a certain way and sees their way of thinking as the ‘norm’. Unfortunately, other neuro-typical individuals do not think like a narcissist and easily see the self-serving behaviour. This is something that escapes the narcissist and they increasingly isolate themselves from others. They start off with a huge sense of self-importance and when they achieve success they can become insufferable. For them, their self-esteem is dependent on striving and achievement. They can very quickly lose their humility (the little that they had to begin with) and others may start avoiding them.
Research suggests that narcissists tend to lose popularity over time. The good is really good but the bad is really bad. On the one hand, a narcissist’s charm and self-confidence can be highly alluring. They come across as attractive, competent and friendly. Being expressive and dominant is often associated with a positive evaluation However, arrogant or combative behaviour is associated with a negative evaluation.
THE EMERGING ZONE AND THE ENDURING ZONE
The “emerging zone” is when a narcissist is on best behaviour, they are keen to win you over and they tend to do well. Where they begin to falter is in the “enduring zone” which involves more long-term associations, continuing relationships and associations.
The costs of narcissism are seen primarily in the “enduring zone” — as the relationships develop the narcissist starts displaying arrogance and self promoting behaviour. There is a cyclical pattern of narcissists wanting to return to the emerging zone.
Narcissists are good at making new friends, being popular and acquiring social status but aren’t as good at sustaining anything meaningful and intimate for very long.
Because narcissists are so addicted to the emerging zone they often don’t see how their behaviours are making it nearly impossible that they will ever gain the deep social and emotional rewards of being in an intimate, close relationship. They will often choose partners that are fairly passive and emotionally vulnerable.
CONSEQUENCES OVER TIME
Long term consequences for a narcissist who doesn’t get help can be:
Depression, anxiety, addiction to rushing, compulsive spending, overconfident decisions, difficulty learning from feedback, volatile leadership performance, poor management skills, romantic volatility in relationships and reduced likeability. Over time people begin to trust a narcissist less.
Individuals who display narcissistic tendencies may find that they increasingly ‘dropped’ by people whom they assumed were friends (once they enter the enduring phase and people get to know the narcissist better).
Without an understanding of their own behaviour, they unwittingly self sabotage and end up depressed and/or anxious. The more we understand ourselves, the better our future interactions with others will be. Perhaps others will also be more tolerant of an individual’s narcissistic tendencies if they understand what might be causing their behaviour.
Everyone deserves happiness and if Meghan does indeed have issues (consider the 9 symptoms) with narcissism, being self-aware would be a good start to reversing the negative impact of this pattern of thinking and behaving.
It is the duty of mental health professionals to use our professional knowledge to educate the public on matters that fall within our areas of expertise, like all other specialities. This does not violate the confidentiality or privacy rights of patients because such constraints on speech do not apply in the absence of a bona fide doctor-patient relationship.
The outdated Goldwater rule needs revising. These changes are necessary because the Goldwater Rule, in its present form, is antiquated, illogical, without scientific foundation, and intrinsically undermining of mental health professionals’ efforts to protect and educate the public.
Mental health should be an open discussion to enable understanding and remove the stigma of what mental health actually is — based in physiology. Mental health issues shouldn’t be seen as negative but rather as a way to embrace all forms of cognitive ability and competence that exist without judgement.
Normalising mental health and talking about it is the way forward.
The DSM and the ICD diagnostic manuals:
International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders DSM are systems that identify and classify diseases once the diagnosis is established. ICD and DSM are identical in some ways and differ in others. However, both systems represent codes and manual for diseases which provide medical informatics such as automated decision support, claims process in medical billing, statistics on morbidity & mortality, surveying epidemic outbreak, etc. as well as for clinical purposes such as treatment, and welfare of public health.
Featured image coutesy of: Twitter.com